Could the Pill Lower a Woman's Sex Drive?

THURSDAY May 6, 2010 -- Women who use hormonal contraception such as birth control pills may be at higher risk for having sexual problems than women who use no contraception or non-hormonal contraception, a new study suggests.

The research isn't the first to find such a link, said Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego and a clinical professor of surgery at the University of California, San Diego. He has found the same link in his own research.

The new study, he said, is "more evidence that when you fool around with hormones, you fool around with your sex life."

The study is published in the current issue of the Journal of Sexual Medicine; Goldstein is the journal's editor-in-chief.

"In general, hormonal contraceptives are well-tolerated and are the best noninvasive method to prevent pregnancy," said study co-author Dr. Harald Seeger, a researcher at University Hospital Tuebingen in Germany. He stressed that the study found a link, not cause-and-effect, and that many other factors come into play that can contribute to sexual problems.

The German research team evaluated 1,086 women, most in a stable relationship with the same partner for six months before answering questions about their sexual functioning and their contraceptive practices.

Using a standard index to measure female sexual function, the researchers found that nearly 33 percent of the women were at risk for female sexual dysfunction. The problems involved a range of factors, such as lack of orgasm, desire, satisfaction, arousal and lubrication.

Most of the women (87 percent) had used contraceptives in the past six months, and more than 97 percent had been sexually active in the past four weeks.

Oral contraceptives were the most popular, used by 69.5 percent of the women, followed by condoms (22.5 percent) and the vaginal contraceptive ring (7.3 percent). Others used a contraceptive implant, intrauterine methods, fertility awareness or other methods.

The researchers then zeroed in on the type of contraception and sexual functioning, excluding 11 women who used more than one type.

Women using non-hormonal contraceptives (such as condoms) were at lowest risk for sexual dysfunction. At next lowest risk were those using no birth control, the study authors found. At highest risk were those using non-oral hormonal contraception, followed by those using oral hormonal contraceptives.

When the researchers looked just at the desire and arousal parameters, both hormonal groups were at highest risk.

"Our data show that hormonal contraception in particular was associated with lower desire and arousal scores when compared with other contraceptives," the authors wrote.

Researchers can't explain the link, but one possibility is that oral contraceptives have been found to reduce circulating levels of androgens, perhaps leading to low circulating levels of testosterone, needed to trigger desire.

Other factors found to affect sexual functioning, the researchers noted, included stress, which was linked with lower desire, and relationship stability, which was linked with higher orgasm scores but lower desire, at least in the short-term.

Denise Bradley, a spokeswoman for Teva Pharmaceuticals, which makes oral contraceptives, said the company had no comment.

Goldstein said the new research points to the need for physicians to warn their patients about the possibility of a sexual dysfunction risk with contraceptive use. "From my point of view, this is more evidence that physicians should spend one extra minute [to tell patients], 'If you want contraception and want to use the oral pill, it may affect your sexual functioning.'"

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